Saturday, December 10, 2011

Guest Post: What it's like to go to an STD clinic.

[I'm busy studying for finals. In the meantime, enjoy this guest post by Jack. I think it's important information for people who've learned testing is important but are unsure what to expect when they actually go through the process. -Holly]

A good friend of mine recently had an STD scare. I figured I might as well get a physical/emotional clean slate myself, and more importantly, go through the experience to support my friend, who has been distraught and has a horror of needles that rivals yours.

[Jack once stuck me with a play piercing needle because we were curious if I would like it. My reaction was a calm and level-headed "GET IT OUT GET OUT OH GOD GET IT OUT AUUUUGH." -Holly]

She did the basic research over the internet and phone; two places in Boston, Boston Medical Center and Mass General Hospital, offer free STD clinics. If you work normal day hours like me, expect to take a day off to get in to be tested – the late Wednesday hours are generally packed, they said. You have to give your name, address, and date of birth to book an appointment.

They take almost every insurance plan. They also do testing free if you have no insurance (and they’re a public health clinic, so they ask if you have insurance but don’t look into it – and don’t much care – if you say you don’t), but only if you are symptom-free. This struck me as kinda odd, and I wasn’t able to ascertain the reason behind it. They test for gonorrhea, chlamydia, syphilis, and HIV; they'll also test for hepatitis C if you request. They also offer the three-shot hepatitis A and B vaccines for free if you want them. This is a separate appointment from your STD testing.

So you walk in and take the elevator up to the clinic; when you walk up to the desk, the desk workers are rather apathetic. “You’re here for what? Huh? Oh. Fill out the form.” They have you fill out a basic form with name/address/phone number/do you have insurance/how did you hear about us, then call you in when it’s your turn.

You have to go in alone; it’s completely private – they wouldn’t let me go in with my friend, despite her and I asking if I could. The actual person who does the testing is polite, warm, and professional, very matter-of-fact but not cold. They explain that the HIV screening is a rapid reaction test with results in 20 minutes, and that the other results take a week or so to come back from the state lab – they do a pretty good job of calmly, simply walking you through everything, showing you lists of information and such, and answering your questions.

One big catch: If you come back positive for anything, you have to come back in to the clinic within a week of that call for more information and (free) treatment, or they turn your information over to the state, which will track you down as a public health risk. Aside from the threat-to-the-public good aspect, everything is 100% confidential regardless of age/status/etc. – apparently even if they have to track you down with the police it’s a private deal; the police bring you to a state doctor who works with you in private.

[Don't get too scared by this--it's actually pretty extraordinary for the cops to hunt someone down for medical treatment--but do be aware you take this risk if you get tested for anything you're not willing to be treated for. -Holly]

The physical part of the procedure is fairly simple: they do the standard spring-loaded finger prick for the HIV test; they put a very small needle (21 gauge) into your arm and draw two small tubes of blood (the needle’s in your arm for less than two minutes, I never even felt it); then they walk you down to the bathroom and hand you the urine cup (“half full, please”) and wait for you, then take it from you when you walk out. The whole thing is very private, very professional, standard doctor’s-office, alcohol-swab-and-stick routine. Your name is not written on the specimens; you're identified only by a number and barcode.

After that they send you back to the lobby (and give you juice and cookies, if you’re like my friend and look chalky-white and like you’re going to die after the needle stick). Within 20 minutes they call you in and tell you that your HIV test was negative (I’m not sure what they do if you’re positive – Bells and whistles? Herd of lemmings? Dunno), and that that roughly means that you aren’t positive, although if you were infected in the last few weeks it may not show up. The other tests take 48-72 hours; if they don't call you, after a few days you can call the phone number and and hear your results over the phone--but if you test positive, they will call you.

[What actually happens if you test positive for HIV is a lengthy meeting with a counselor to tell you "this does not mean you're dying, you can be healthy for many years after this, but we need to get you started on treatment ASAP and here's how that's going to work." They also retest you with a slower but more accurate method to make sure. -Holly]

They reiterate the we’ll-call-you-if-bad, you’ll-hear-a-few-days-later-if-it’s-good, feel-free-to-call-after-a-few-days-if-you-want-to routine, and then they wish you a good day. Other than the apathetic desk attendants it was professional and friendly friendly, anonymous, non-judgmental, and pretty low-key.

36 comments:

What's the advisability of paying for this sort of thing with insurance? I once had a doctor's office refuse to give me a preventative HIV test because "you wouldn't want your insurance to know", and told me to go to a free clinic instead. I thought this was very strange.

Glenn - Honestly, I think it's a moot point because if you're positive you'll have to bill your insurance for the treatment and they'll find out. (If you're negative, well, that's that; I've never heard of an insurer taking action against someone just for getting tested.)

It is illegal for a health insurer to drop you because you test HIV positive.

Just an FYI for any readers in England (Not sure about the rest of the UK, don't want to make assumptions): it's pretty much the same, but without all the insurance stuff, and they may not make you wait around for the HIV result, and can just tell you along with the other results (by text in some areas).

It's basically no more awkward or weird or scary than going to see your GP or dentist, or having a regular blood test, etc.

Last time I wanted STD testing I went to the GUM (genito-urinary medicine) clinic at the local hospital. The system was pretty much as described here, although they don't do the fast HIV test. Notably they DO take a sexual history, which can feel intrusive even though the doctor remained non-judgemental. Oh, and there are vaginal/cervical and urethral swab tests for, er, some diseases I forgot. And urethral swabs FUCKING HURT (me); blood tests are much easier.

Shocked at the idea that test results can be passed to the police over there! However the procedure is pretty similar to my 3 monthly checks. I think anyone who isnt celibate should get tested regularly, embarrassment seems to be the main reason people cite not too.

So empathize with Hollies' fear of needles...My master suggested it was daft for a women with piercings to have a needle phobia...he will find out just how quick I can move if he ever comes near me with a needle.!

And for the Dutch folks; the GGD (Gemeentelijke gezondheidsdienst) also offers free STD checks. Call them to make an appointment, show up. The process is pretty much as desrcribed above. They'll need your name and phone number. No info is shared with anyone unless you want them to. The GGD doesn't give immediate results regarding HIV, the samples are sent off to a lab, and you'll be notified by text message about the results (takes about ten days). As I've never tested positive for anything, I wouldn't know anything about followups.

I used to work in a doctor's office, and we sometimes had patients choose not to use insurance if they were trying to hide their visit from the primary insurance policy holder. It's actually fairly easy for the primary policy holder to find out what services have been charged to their account, even if the doctor's office keeps everything confidential. So someone who is trying to keep their parent or spouse from finding out that they think they have been exposed to an STD should, IMHO, consider paying out of pocket.

A good 15 years ago when this sort of thing first became relevant for me, there was advice going around for USA residents to avoid charging such things to insurance if possible. The rationale was that while they couldn't drop you if you tested positive, they *could* take your getting regular STD tests as a sign that you belonged in a higher-risk group and raise your premiums or potentially deny you coverage if you later got something (because of your risky behavior).

I have no idea if this is legal, or if it's still relevant, or if they do it even if it isn't legal, but that was the reasoning I'd heard.

I just have this done with my monthly set of blood tests that have to be done anyway. Funny when you have a chronic illness you forget that not everyone has to have someone stick a needle in their arm every month.

When I took the biosafety course for lab I was working in at my old university, the instructor told us that we should get HIV tests anonymously because if our records showed that we've been tested our supplemental insurance premiums would be higher. I have no idea if this is true, and this is in Canada, so supplemental insurance is only for things the government doesn't pay for.

When I went to a family planning centre rather than a student health centre (which is run more like a doctor's office), this was basically the procedure, minus asking about insurance. I think the policy used to be that you only get tested for HIV if you think you're at risk, but now they've changed it to everyone should get tested once a year - the same for gonorrhea, chlamydia, and syphilis.

The HIV test is a 60-second point of care test with a finger prick and the other tests are a swab done at the same time as my annual pap smear. Not sure what they do for guys but I believe it's peeing in a cup.

And regarding your HIV status - here it's a publicly reportable disease, meaning they want to keep track of the number of cases and where they occur. That said, it's entirely confidential, and they won't hunt you down to get treated (certainly not involving the police!); you get counselling about your options along with the 60-second test. If you test positive, there's a really neat program in place where if you want, they can track down and anonymously notify your past (and current) sexual partners for you, so you remain completely anonymous but they can get tested and treated themselves. Win-win.

Ah, after reading more of the comments I have to add that they did take a sexual history at the clinic, but that goes along with the pap smear, not with the HIV test (which I did separately because my school was trying to promote them around AIDS week last week). The questions with the HIV test were more of a checklist of any activities that could put you at risk, so partly sexual history but other things too.

Oh man, long time reader finally de-lurking. I am glad this was written and glad the staff was professional for your experience. I guess this hit a nerve because I have been STD tested a bunch and encountered a few really horrible, slut-shaming people which is not a fun experience when you're in stirrups. I was asked by one nurse "well, what were you wearing?" when I said I hadn't wanted genital contact with someone and was itchy--I was wearing a bikini because we were in a pool! Totes my fault, right?

A few other things happened to me in El Paso too--I think that city has some um, inherited attitudes when it comes to sex. I told one lady that I was getting tested because I had had unprotected sex without asking a guy his history and she replied "Oh honey, why even bother, they just lie to you anyway." Really? You are a health professional? Another lady taking my sexual history when I was 24 and replied "No" to "Have you ever been pregnant," felt the need to rephrase because she couldn't believe it apparently--"No miscarraiges, no abortions, you've never been pregnant??" No, I've never been pregnant. I understood your question.

I wish everyone better experiences at public health clinics than I've had, because it is important to get tested. I did ask the first slut-shaming lady if she gave the whole "keep your penis to yourself" lecture to all the guys too because that would probably be more effective. Argh.

Thanks for this blog Holly, I've enjoyed it for over a year and enjoy your input at Captain Awkward too (which I need to de-lurk at one of these days!)

For UK based readers you can also get tested by your GP (General Practitioner) although it is slightly more complicated as you have to take various pots and swabs away and drop them off later (something to do with the first urine of the day being a better vintage for testing). The downside to this is that the test goes on your medical records which can affect private health care premiums; the GUM clinic will test anonymously.

The Australian version is much like the UK. I went to one of the free clinics available in every major Aus city, their official name has "Infectious Disease Control" in the title, but are known as Clinic 256 (or whatever their street number is). A sexual history is taken; then because I was asymptomatic, I only did self-administered vaginal & anal swabs, and had blood taken. I believe that they will only personally look at your junk if you're having issues.

I was told to come back in a week to collect results, at which point, if you've tested positive for any of the major ones (chlamydia, gonnorrhea and AIDS), then they offer to contact all your prior partners for you, or you can promise to do it yourself.

Long answer short, it's probably not as scary as you think, even with a needle phobia.

It wasn't as traumatizing as expected, even for my friend (who was far more worried than I was -- again, I was mainly there for moral support and a little closure of my own). I was surprised how not just professional, but warm, the tester was -- I honestly expected lower quality, given that it was a public clinic.

@DC -- I'm sorry you've had some crappy experiences with the slut-shaming. There's no excuse for that. That sucks.

Overall, I'm glad I went, and not just for my friend. It's smart, it's emotionally relieving, and it's responsible. Given that I play outside my marriage, my wife is happy, too. A good experience all the way around.

Jack

P.S.: Holly is exaggerating her reaction to the play piercing needle on Hatchet Night. She wasn't NEARLY that calm. :)

Chiming in with more UK experiences: you can very easily get a chlamydia self-testing kit from your local GP - you do the test at home (pee on a stick if you're male-bodied, swab if you're female-bodied), return it to the GP and get contacted with results. There's a lot of incentivising going on to try and get young people to do these tests - at my university I encountered a scheme wherein anyone taking and returning a chlamydia test got free cinema tickets as a reward. I'm sure there were some virgins getting tested for chlamydia just to get the free cinema tickets...

As far as other tests go: I've had cervical exams done by a GP, but said GP then referred me to a GUM clinic for STD testing. This seems to contradict the claim by Anonymous at 5:23 that GPs can give you STD tests. I'd guess that some GPs have some STD testing facilities, but if you are UK-based, check the situation with your GP rather than assuming they can test you.

(Oh, also: in the taking-sexual-history part of the exam, one thing that really stood out and made me very happy was this: nobody made any assumptions about the gender of my partners without asking me first. I know this shouldn't be notable, but it kind of is.)

I go to my local Planned Parenthood for testing and I've never had a problem with attitude. It can be expensive if you don't have insurance, but you can call to make an appointment so it doesn't take extra time off.

This isn't really an issue for me right now, but if you work a normal 9-5 job, you basically need to be prepared to take 2 days off work for this. You need 1 day for the first appointment, and then if you're positive, you need to come in again to avoid the police getting involved. That is kind of a lot to ask of some people.

In my (West Coast Canadian) experience the nurses running the desk were so much more helpful then the actual doctor. Once I explained I was a virgin; he pretty much refused to screen me for anything...because obviously if I can attract unicorns - partners should just take my word at face value apparently.

Went home, popped a benzo, and cried myself to sleep. :( I'd signed up to volunteer for the clinic too before visiting, I'd just been starting to read sex-positive stuff and figured a yearly screening was a Positive Thing to Do (tm).

I thought about why they might give tests for free if you have no symptoms. I wonder if maybe it's because some STDs have no symptoms in some people, but not everyone knows that, so they might just assume they are STD-free if symptomless, and therefore not spend money to get tested (esp. if money is scarce). So maybe from a harm reduction POV, the clinic would rather do the tests for free then have symptomless, yet infected people going around acting as if they are uninfected. Just my theory.(I assume the rationale is, if you have symptoms, then you'll know something is up and at least not have unsafe sex (hopefully) even if you can't afford the test or to get treated).

God, chalk that up to another thing I'd wish I'd known about the last time I got dragged in for one of those horrors. Could've been spared the whole, "Oh yeah, you want birth control? Never had penetrative sex with another body? We have to give you a surprise rectal exam and you're going to shell out a hundred dollars or two for the privilege. Now, relax or we'll have to do it again!"

I apologise for any offense, but I have a question: if you're a non-intravenous drug using virgin, what sense would it make for you to use $200+ dollars of health care equipment/time to get yourself tested for STDs? It's like a variant of that old joke about the elephant-repelling rock (for the record, the joke is based on the idea of having a repellent device for an animal that doesn't exist in a specific area) : if you haven't done anything to contract a transmissable disease, why spend money (and government/tax money at that!) to prove it? It's as sensible as receiving a yellow fever vaccine when you aren't going to a tropical area, or spending money on insulin when you don't eat sugars/starches/processed food.

I've spent a decade of my life working in the health care field (and for the federal government at that.)The time that's spent on giving you peace of mind is time that's taken away from actual sick/diseased/injured patients (and that's without taking the expense of testing materials, some of which are difficult to replace.) The time and money spent on your request could be time and money spent on a "slut" (or a rape victim, or a molested child, or a person who's learned that their spouse has been cheating on them, or a person who was exposed to an ill patient. As someone who's actually *given* unprotected rescue breathing to a few people who were later diagnosed with STDs, I've *been* the guy who was forced to wait 7+ days for new testing supplies. 7 days in which I didn't know if I'd contracted hep C or some other blood-borne pathogen because the person who was dying in front of me had bleeding gums.) I can sympathise with the idea of wanting extra assurance, but vilifying a doctor (a doctor whose bosses have an obligation to the taxpayers by *not* wasting money) for that decision is shortsighted.

Sorry for the thread derail, but people who use "free"/subsidised/taxpayer-funded medical care as a way to every paranoiac health quibble is a pet peeve of mine. Do people *deserve* ready access to health care? Yes. Should health care be affordable (if not free?) IMHO, yes. Does that mean that money should be spent to diagnose impossible illnesses (never mind the diversion of manpower and manhours?) IMHO, no. It's wasteful, it's frustrating (for the workers) and aggravating (for the patients who are inevitably left in the lurch if/when supplies run out, as based on overuse or manufacturer shortages. Drug shortages and equipment shortages occur on a weekly basis all over the world.)

But, back on track: the idea of women being libido-free is an invention of the Protestants. AFAIK, no other culture on the entire planet has ever considered women to be totally free of the "sins" of lust and/or desire. I mean, any guy or girl whose ever taken the time to bring a woman to a multiple orgasm knows that the female of the species is more horny than the male. And as soon as I typed those words, I remembered that (during my time in the military) I met a *bunch* of suburb-bred, middle-class guys who learned everything about sex from porn and "keeping up with the Joneses"-led sexual repression (the type of repression that leads to sex being enjoyed in quick, <5 minute bursts if at all. IOW, in their minds, a woman who couldn't orgasm in <5 minutes of furtive penetration was all but frigid.)

In a world where a partner's being able to show proof of being free from STDs is a reasonable thing to ask for, no, it's NOT unreasonable for someone who is not in fact at risk to get tested. They're not getting tested for themselves. They're getting tested to PROTECT THE OTHER PERSON, who is well within their rights to request such proof. Same as every pint of donated blood getting tested. *I* know I'm not at risk of AIDS. The blood bank doesn't know that for sure, no matter how much paperwork I sign, and the person who's going to get my blood sure as hell doesn't know that.

I was referring to her reaction to being dismissed by her doctor, not by the dismissal itself.

If a man went to a fertility clinic and simultaneously asked for a sperm motility exam/admitted that he has both testicles removed two years prior due to cancer, he'd be dismissed in the same manner.

If a 60+ year old woman visited her doctor and simultaneously asked for a pregnancy text/acknowledged that hitting menopause in her 30's was an unforseen blessing, she'd be dismissed in the same manner.

Her desire to be a conscientious lover is admirable, her framing for the request (which was, once again, claiming to be a *virgin* while asking for a STD check) and subsequent drug use after being "dismissed" as a (probable) time waster was what caught my eye. Believe me, I've had weeks in my career in which I was convinced that the people at my base were literally playing "musical 'clap' ", I know from patient-based frustration.

Isn't there a considerable public health value in encouraging people to show each other clean bills of health before engaging in intercourse? and isn't that worth a few "wasted" visits? I don't see that as being at all like refusing to test a guy who's been castrated for sperm motility (talk about a straw man...). The kind of examples you give could all be solved by having the person show the medical record they *already have*. There IS no medical record for never having had intercourse.

@MaMu1977 I think you kinda have the wrong idea regarding the events of that day. :p I was seriously sleep deprived (poking essays with a stick at the last minute) and didn't give as good of a summery of that day as I *probably* should have. I fully understand where you are coming from and all, but this was just a dude being a prick. :P

I didn't waltz in wearing my lack of sexual history on my shirt - it came up as a result of discrepancies on the personal history form I filled out when I showed up. I was not gibbering irrationally either - he just happened to be making a counticious effort to be a total cock from the moment I walked in the door. I've dealt with many doctors, and I'd say he was the first to just actively be a dick I've run into. I could understand him acting as such if it was busy, and I really was trying to waste his time as per your points...except the place was totally dead, he refused to discuss anything beyond signing a bloodwork form for STD testing (this wasn't the only reason I was visiting fyi) - and I'm talking about general questions too, not "please test me for xyz, I think space jews are trying to steal my cerebral spinal fluid". He also resisted my attempts at politely(!) ending the appointment early.

The subsequent drug use wasn't recreational - I have a script for a limited supply of lorazepam (legally obtained at that) for anxiety attacks/whatever the hell. I could take one, fry my short term memory, and sleep the rest of my day off...or I could be a crying wreck for longer then I would like to be.

Bottom line is that I've never been treated like this by any other health-care professional I've seen - and I'm pretty certain they would have picked up if I was wasting their time or not.

California takes it a step farther(though I don't know if this is California in general or if it is Planned Parenthood)and you have to tell them the date of your last period(for females) when the last time you had sex was, how many sex partners you've recently had etc....it is highly intrusive if you are shy about that kind of stuff like I use to be. And some of the questions they ask make it feel like I'm donating blood to the blood bank. But whether I am sexually active or not I go and get tested at least once if not twice a year(depends on if I am sexually active or not)

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They don't actually turn you over to the police for a positive result.

However, STD's are "reportable diseases" in most locales in the US (as is tuberculosis and most contagious diseases). They have to track down your recent partners (how recent depends on the state) and encourage them to get tested. Confidentiality is maintained -- usually one person solicits the list of partners and a different one tracks them down for testing. The Disease Intervention Specialist (as they're call in Texas) doesn't even know why someone is on their list; they're just told to find so-and-so and try to get them to test for syphilis (or whatever).

It may seem a little intrusive, but it really is a good idea, since people are not so keen to track down their old partners and let them know they've been diagnosed with the clap. It balances privacy and public health well.

After my recent nightmare of an experience getting an HIV test from my primary care doctor (US) I have made it a point to advise all my friends to get tests done only at clinics that handle these tests routinely.

What happened: I called late one afternoon, thinking it was about time for results to be done. It's worth noting that my doctor asked zero questions about my current risk or why I was getting tested beyond asking about symptoms. I got a call back at 4pm from the nurse, who told me that my HIV test result was "indeterminate". She couldn't explain what that meant. My doctor, who called me back the next morning, didn't give a very good explanation (google was more informative). She referred me to an infectious disease specialist who never called me.

In the meantime, as someone lucky enough to feel comfortable talking about this with my friends and partners, I got referred to a friend of a friend who was really informative and another friend took me by a testing facility where I got a repeat test. (Negative by the way - as I was very, very sick just prior to taking the first test it was probably partially reactive due to other viral stuff going on at the time.)

When I went back to my doctor a couple weeks later she actually had the gall to ask for proof that I'd followed up and gotten a negative test result.